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autologous blood and marrow transplantation - Blog Science ...

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Janssen et al.<br />

RELAPSE FREE SURVIVAL BY STEM CELL SOURCE<br />

ALL PATENTS ENTERED ON STUDY<br />

AjJi--H-"h-+•+--+• +<br />

BMSC (25)<br />

PBSC (22)<br />

BOTH (23)<br />

4H—r— m—:<br />

+<br />

P = 0 . 8 4 6<br />

H H h<br />

6 12 18 24 30 36<br />

MONTHS AFTER AUTOLOGOUS STEM CELL TRANSPLANT<br />

Figure 6. Relapse-free survival, all patients: Kaplan-Meier representation of the proba<br />

bility of relapse as a function of time after stem cell transplant. In this analysis, toxic de<br />

are treated as censored data at the lefth<strong>and</strong> side of the plots.<br />

alternative to the use of bone <strong>marrow</strong>. In fact, it is widely contended that PBSC<br />

autotransplant is superior to BM autotransplant. 4<br />

This contention is based on the<br />

premises that 7) PBSC collection is safer due to the lack of need for general<br />

anesthesia <strong>and</strong> 2) PBSC transplants produce more rapid engraftment of neutrophils<br />

<strong>and</strong> platelets than do BM transplants. 7<br />

- 9,1019<br />

591<br />

42<br />

As a principal result of this latter<br />

observation, it has also been suggested that the PBSC autotransplant is safer due to<br />

reduced risk of opportunistic infections <strong>and</strong> less expensive due primarily to fewer<br />

days of posttransplant hospitalization. 4<br />

We observed that all of the reports of accelerated engraftment after PBSC<br />

transplant were comparing mobilized PBSC with bone <strong>marrow</strong> that was resting<br />

(i.e., no growth factors were given <strong>and</strong> many weeks had transpired since last<br />

chemotherapy exposure) at the time of harvest. Further, we were unable to find any<br />

reference in which unmobilized PBSC were transplanted <strong>and</strong> in which the effect of<br />

accelerated engraftment was reported. 17,18<br />

There were preliminary reports,<br />

however, in which it appeared that bone <strong>marrow</strong> harvested after growth factor<br />

stimulation could produce more rapid engraftment. 30-35<br />

To account for all of these observations, we hypothesized that the treatment<br />

that mobilizes PBSC <strong>and</strong> not the anatomic location from which they were obtained<br />

is responsible for the rapid engraftment observed following PBSC autotransplant.<br />

This hypothesis would predict that in a r<strong>and</strong>omized comparison of mobilized<br />

PBSC with resting BM for autotransplant, PBSC transplanted patients would

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